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Am J Obstet Gynecol. 2005 Nov;193(5):1790-3.

Teaching residents coding and documentation: effectiveness of a problem-oriented approach.

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1
Division of Advanced Laparoscopy and Gynecologic Surgery, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.

Abstract

OBJECTIVE:

We sought to assess the effectiveness of a problem-oriented approach to teaching residents accurate coding and documentation of ambulatory gynecology visits.

STUDY DESIGN:

This was a pilot before-and-after study. Nine resident volunteers underwent 4 individual instructional sessions on coding and documentation with a trained faculty member over 6 weeks. Outcomes were assessed by comparing the appropriateness of procedure and diagnostic codes billed in participant continuity clinic prior to and in the 6 to 9 months following the intervention.

RESULTS:

Following the intervention, participants demonstrated an increase in the accuracy of coding the correct category of the evaluation and management service, an increase in the appropriate use of modifiers, and a decline in undercoding errors.

CONCLUSION:

Problem-oriented interactive learning appears to be an effective method of teaching residents proper coding and documentation.

PMID:
16260235
DOI:
10.1016/j.ajog.2005.08.004
[Indexed for MEDLINE]
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